Tobacco use is the leading cause of preventable disease and death in the United States, killing more than 480,000 Americans a year. For 17 years, our "State of Tobacco Control" report has tracked and graded efforts to reduce tobacco use by state and federal governments. Over this time, the tobacco prevention and quit smoking policies called for in our report have been a remarkable public health success story, resulting in record lows for both adult and youth cigarette smoking rates. However, new factors, especially the dramatic rise of e-cigarette use among youth warn us that this hard-won success could be fleeting.

Youth use of highly addictive e-cigarettes has sky-rocketed to what the U.S. Surgeon General calls "epidemic" proportions. E-cigarette use increased by a staggering 78 percent among high school students from 2017 to 2018 and use by middle school students—kids as young as 11—increased 48 percent. Overall, more than 1 million additional kids began to use e-cigarettes in the past year.

Studies show that youth who use e-cigarettes are more likely to become cigarette smokers. Today's e-cigarette epidemic could set the stage for another generation of Americans addicted to tobacco products and ultimately more tobacco-caused death and disease.

To many, solving America's tobacco crisis might seem like a complex puzzle with no solution. And yet we have known for years what pieces are needed to reduce the disease and death caused by tobacco use.

Our country's federal and state policymakers must act to put in place the policies called for in "State of Tobacco Control" that are proven to reduce and prevent tobacco use—including e-cigarettes. Unfortunately, "State of Tobacco Control" 2019 found a disturbing failure by federal and state governments to take meaningful action, placing the lung health and lives of Americans at risk.

Lack of action has also emboldened tobacco companies to be even more brazen in producing and marketing products squarely aimed at kids, such as fruit and candy flavored products, and the JUUL e-cigarettes that look like an easily concealed USB drive, which now dominate the market due to youth use.

"State of Tobacco Control" provides a clear blueprint for what states and the federal government need to do to halt this epidemic:

  1. Pass comprehensive smokefree air laws to protect their citizens from exposure to secondhand smoke in all public places and workplaces.
  2. Increase tobacco prevention funding. The Centers for Disease Control and Prevention (CDC) has recommended funding levels that each state should be spending on tobacco prevention programs. However, no states are currently funding tobacco prevention programs at or above the level recommended by CDC.
  3. Increase tobacco taxes by $1.00 per pack or more. Tobacco taxes are highly effective at preventing youth tobacco use.
  4. Increase the legal age of sale for tobacco products to 21, which would help limit youth access to tobacco.
  5. Help Smokers Quit by ensuring that all state Medicaid programs and state employee health plans cover a comprehensive tobacco cessation benefit, and fully fund state quitlines.
  6. FDA must take concrete action to limit the manufacturing, marketing and sale of tobacco products, including eliminating all flavored tobacco products from the marketplace.

You can learn more about these tactics and your state's grade at

When we look at these and other pieces of the puzzle, we get a clear picture of what works and is urgently needed to end America's tobacco epidemic. The only piece that's missing is the political will to do it. We call on lawmakers, both state and federal, to take action, do their part and consider the lives that could be saved if they put in place the proven tobacco control policies called for in "State of Tobacco Control" 2019. You can help by raising your voice with us.

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